In-depth Insight on Important Issues

Indian River County District Trustee Speaks Out

AT THE OCTOBER 16, 2O14 PUBLIC MEETING OF THE INDIAN RIVER COUNTY HOSPITAL DISTRICT (IRCHD) Trustee Burton Lee, III MD, addressed Indian River Medical Center (IRMC) President/CEO Jeff Susi and Attorney William Stewart offering his serious concerns about the management of the IRMC.

Dr. Lee is a retired oncologist who has served District six as a IRCHD trustee for 12 years. He has withdrawn his candidacy for reelection and will be replaced by James Seaton, who is now running unopposed.

The following is an outline of Dr. Lee’s concerns, which we have paraphrased, except where noted with specific quotes.

Dr. Burton Lee MD Speaking out at IRCHD Meeting:

1. Why does the Medical Center seek reimbursement of expenses for indigent medical care based on its “costs” rather than what the US Government pays for US indigent care through Medicaid? “Nobody pays costs as determined solely by a contractor.” Despite our fiduciary duty to the taxpayers and oversight of the Medical Center, the Hospital District has no control over those costs.

2. The Hospital District did not approve the Medical Center’s acquisition of Vero Radiology at a time when “loudly touting operating on a debt free basis and now you have a large loan.”

3. The Hospital District reluctantly approved the Cancer Center despite concerns about its long-term costs to the Medical Center. As a condition of our approval the Hospital District “extracted a promise” from the Medical Center Chairman of the Board to the late Hospital District Trustee and Treasurer Trevor Smith and Hospital District Chairman Thomas Spackman that the Medical Center would provide the Hospital District with a reporting on the financial and business practices of the Medical Center. Subsequently, the Chairman denied making that promise and the Medical Center only “allowed Hospital District Chairman Dr. Thomas Spackman and Hospital District lawyers to review this material on Medical Center premises.” As fiduciaries for Indian River County taxpayers the Hospital District is responsible for “proper operations” of the Medical Center and the inability to access this information is “unacceptable.”

4. A prominent Medical Center doctor asked a member of the Medical Center’s Board of Directors why the Medical Center chose a particular computer system mandated by the Affordable Care Act integral to every function in the hospital and was told it was “because it was the cheapest. I find that answer to be unsatisfactory.”

5. There is little or no financial transparency regarding the “recent mass hiring” of physicians “at salaries some of which are questionable” and the acquisition of “boutique practices” and the financing thereof.

6. According the Chairman of the Medical Center Board of Directors, there will be “no adverse questioning asked of Medical Center administration or the CEO on his watch.” This is a practice of stifling questions.

7. There has been no explanation for the “unprecedented and illegal lynching” of former Medical Center Board member Mr. Paul Nezzi for asking why Medical Center Foundation funds were added to the the Medical Center’s CFO’s balance sheet in order improve the “cash balance.” Nor has there been any discussion with the Hospital District as to why Mr. Nezzi was fired “in a closed and secret meeting.”

8. How could the Medical Center have made a mistake on is tax returns for the past two years regarding early SERP (Supplemental Executive Retirement Plan) withdrawal of pension funds, for three individuals, when those tax returns were reviewed by “10 different boards, committees and responsible people, particularly when at a time when 80-90 people were being fired, the balance sheet was obviously unsatisfactory and funds were low?” The Medical Center called it an error. The Hospital District asked the Medical Center to discuss this before us but the Board of Directors “did not return the favor…where is the money?”

9. There is a “defect in Emergency Room protocols and planning” when a vascular surgeon while on call did not show up to treat a woman which ultimately caused the loss of her leg and her life because she was not treated and was referred to an inappropriate trauma center. Multiple doctors did not show up at multiple locations.

10. “There is another longstanding issue of poor cooperation and congeniality between the medical staff and the administration.”

“Ladies and gentleman of the viewing audience,” said Dr. Lee, “this hospital is being badly run.”

In response to Dr. Lee’s comments, Medical Center Attorney William Stewart made the following remarks:

“That’s quite a laundry list of negatives that you strung out…some of the facts you have stated are not accurate…I would think a responsible way to present the shortcomings that you perceive, rather than in a speech in a public setting would be to set them out in some sort of white paper and then develop a procedure for trying to resolve them and getting answers…there were so many of them (questions) it would be hard to keep track of them all…certainly I can acknowledge that communication might be better between the District and the Medical Center, in both directions…if there are perceived problems that the District has, I would suggest that you outline them in some formal way and some process can de developed where those answers can be given, but to display those concerns in this setting when you know that the Hospital is not going to be able to respond effectively…it’s a little unfair.”

Further, Attorney Stewart said: “We will be prepared to answer to those questions if you put them in some sort of format that can be answered.”

In response to Attorney Stewart, Dr. Lee said: “The reason that this was brought up today is that this Board represents the taxpayers and if we see irregularities… we have an obligation to get those answers and to bring them up in this public forum…we do have an obligation to the taxpayers and that’s why I’m putting my head on the block.”

When asked for public commentary at the close of the meeting, Laura Moss, a Vero Beach resident and candidate for the District Two Trustee position spoke to the trustees.

“I have spent the last few months spending a lot of time out in the community and the questions that Dr. Lee raised are questions the that community as a whole has and I found many people are asking those questions and I strongly recommend the Hospital answer those questions as fully as it is able to do because they are not simply Dr. Lee’s questions but they’re the questions of the community.”

We organized the remarks made by Dr. Lee, as above. While Attorney Stewart indicated: “it would be hard to keep track of them;” we believe the 10 points above are the issues raised by Dr. Lee to which the District seeks a response.

Perhaps our Communiqué has provided a service both to the Hospital District and the Medical Center by having organized Dr. Lee’s remarks and creating an opportunity for the Medical Center to respond point by point in a fashion similar to President/CEO Jeff Susi’s letter to his colleagues and friends to apologize for Emergency Room wait times; or in a white paper to be published to the community. This would certainly improve communication between the Medical Center and the Hospital District; as well as to help calm the community. We would be pleased to participate in and publish such a communication.

{I was scolded once by County Commissioner Peter O’Boyle for inserting my own personal opinion into an article about the Oslo Boat Ramp Expansion, so I want to make it clear the following is my own personal opinion, or commentary, if you wish.

During the Medical Center’s Board of Director’s Meeting on October 23, following the Hospital District Trustees Meeting on October 16, to be reported on below, Board Member Dr. Hugh McCrystal’s cell phone rang loudly, causing one Board member to say, while others snickered, “it must be the District.” Someone suggested, while snickering, that the loud and crazy ring tone was a signal from the District. This, to me, is troubling, as it evidences the disrespect the Medical Center Board feels toward the District at a time it is receiving upwards of seven to nine million dollars in funding (depending on the renegotiation of the Indigent Care Agreement) from the Indian River County taxpayers for reimbursement of indigent medical care.}